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Acute Gout — RACP Adult Medicine MCQ

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ModerateRheumatologyAcute GoutRACP Adult Medicine

A 55-year-old man presents with an acutely swollen, hot, erythematous first metatarsophalangeal joint. Synovial fluid aspirate shows negatively birefringent needle-shaped crystals. He has CKD stage 3b (eGFR 35 mL/min/1.73 m²) and takes apixaban for AF. Which agent is most appropriate for acute flare management?

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Correct answer: A — Prednisolone 25–35 mg daily for 5 days

With CKD stage 3b and concurrent anticoagulation, NSAIDs (including indomethacin and naproxen) are contraindicated due to renal risk and bleeding risk. Colchicine dose reduction is needed in CKD but can interact with apixaban. Oral prednisolone (25–35 mg/day for 5 days) is the safest option in this setting. Intra-articular corticosteroid injection is an alternative for monoarticular disease.

Reference: eTG – 2025 – Rheumatology; ACR – 2020 – Gout Management Guideline